The Los Angeles-Long Beach area ranked as the nation’s smoggiest region in a report released today by the American Lung Association, which also faulted the region for short-term and year-round particle pollution.

The association’s annual State of the Air report overall found that nearly half of all people in the United States breathe unhealthy levels of air pollution, with 156 million people living in regions that received “F” grades for either smog or particle pollution.

Los Angeles-Long Beach was found to have the worst ozone, or smog, pollution in the country. Five areas of California were listed among the top 10 most polluted areas, with Visalia placing second, Bakersfield-Delano third, Fresno-Hanford-Corcoran fifth and San Diego-Chula Vista-Carlsbad eighth.

“Ground-level ozone pollution, also known as smog, is a powerful respiratory irritant whose effects have been likened to a sunburn of the lungs,” according to the Lung Association. “Inhaling ozone can cause shortness of breath, trigger coughing and asthma attacks and may shorten life. Warmer temperatures driven by climate change make ozone more likely to form and harder to clean up.”

The Los Angeles-Long Beach region was ranked the seventh-most polluted region in the country for short-term particle pollution, and fifth-worst for year-round particle pollution. The short-term figure represents daily spikes in particle pollution, or soot, while the year-round figure is an annual average.

On a countywide level, San Bernardino County was ranked as the nation’s most ozone-polluted place to live, followed by Riverside, Los Angeles, Tulare and Kern counties. Kern County also topped the list as the most polluted county in both short-term and year-round particle pollution.

Los Angeles, Orange and Riverside counties all earned failing grades in the report for all three pollution categories, as did Fresno, Imperial, Kern, Kings, Madera, Merced, Sacramento, San Bernardino, Stanislaus, Sutter and Tulare counties.

“Families across the U.S. are dealing with the health impacts of air pollution every day, and extreme heat and wildfires are making it worse,” Lung Association President/CEO Harold Wimmer said in a statement. “Air pollution is causing kids to have asthma attacks, making people who work outdoors sick, and leading to low birth weight in babies. This year’s report shows the dramatic impact that air pollution has on a growing number of people.”